330 Joe RoadDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina- Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ilTct��C.C_ t r��NU- RT,� (3 +�74� D' Cj- 1 7 r 3702
y;.LocKSV10��
LocationAS`r g.; A -'r rlou:, C!s" X1C'r,; ',yx
?01,.J!Nf�
Subdivision Name Lot No. Sec. or Block No.
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply _
*This permit Void if s
House ""� Mobile Home _ Business Speculation
_ No. Baths i No. in. Family
YES ❑ NO p'` Specifications for System:
YES NO '❑ ,�
YES p NO ❑ IDD �1' 3 .� I Z Si n��
a e system described below is not installed within 36 months from date of issue.
1
.M.=+..s` ..--� '`•`-'mss
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: y System Installed by VoC�t��►iZ.F.r6-.�z.�''R�T-�'�
Certificate of Completion Date��
*The signing of this certificate shall indicate that the system describ above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
`DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name
Da 7- Y�" 3f02
/�IJGKi1/CC�, N—
Location %,Ll En sr A S r� �t r. � ; a,z f_ Oou s 91(3t, -r-
L -J �7 i, C- (_ i"'i i s
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _— Speculation
No. Bedrooms -� No. Baths No. in Family Z- _
Garbage Disposal YES ❑ NO F-1"
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑
Type Water Supply W L
Specifications for System:
/D0�.1
*This permit Void if sews a system described below is not installed within 36 months from date of issue.
i
� e�Crr
u�
r�
77
,12 it i d
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by-"'`'��-�`-���Fi-tom``
Certificate of Completion Date��
*The signing of this certificate shall indicate that the system descrI above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.